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medsurg exam 3
pulmonary conditions part 2
| Question | Answer |
|---|---|
| determining who is at risk for asthma is more complex than | COPD |
| risk factors for asthma | genetic - "atopic" family history of allergy environment - less exposure to allergens in childhood, occupational exposure |
| people with asthma have hyperreactive airway which causes what when theres an encounter with trigger | release of inflammatory mediators |
| hyperreactive airway | airway hyperresponsiveness due to exaggerated contractile response of airways |
| encounter with trigger | allergen (allergic cause) irritant (non allergic cause) exercise induced |
| allergic asthma | Initial allergen exposure Allergen specific IgE antibodies synthesized and secreted IgE antibodies bind to high-affinity receptors on mast cells Allergen is inhaled, cross links on mast cell surface Followed by mediator release |
| non allergic asthma | Results from encounter trigger |
| triggers for non allergic asthma | Strong odors Air pollution Chemical Exercise |
| symptoms for non allergic asthma | same as allergic asthma |
| asthma triggers allergens | Pollens Dust mites, mold, pets Foods – peanuts, nuts |
| asthma triggers non allergens | Smoke, air pollution Chemicals, perfumes |
| asthma triggers occupational | latex |
| why is asthma more common | hygiene hypothesis |
| hygiene hypothesis | “clean lifestyle” Don’t develop immunity as child Contact with allergen Respond with sxs asthma |
| Why sx difficult to control some pts? | Severe asthma phenotype - high number of eosinophils |
| asthma self management | cant avoid triggers entirely identify and avoid triggers - could keep a diary monitor success |
| monitor success | Symptoms – how often, when happen Peak flow monitor - effect airflow Asthma action plan – what to do & when |
| how does pt know if symptoms are severe? | by using the peak flow meter |
| peak flow meter | measures the speed gas leaves lungs and provides numbers for self management |
| three zones for peak flow meter | green yellow red |
| green zone | 80-100% personal best |
| yellow | 50-80% personal best |
| red | < 50% personal best IN TROUBLE!! |
| how does a peak flow meter work | Move dial to bottom Stand up Deep breath Blow into device hard & fast Record value Repeat X 3 Use highest value |
| what meds are used for symptom control | relievers (onset is 1 min and lasts 4-6 hours) standard controllers (onset is 5 min and lasts 12-24 hours) biologic controllers (lasts 2-4 weeks) |
| relievers | Dilate airways SABA Airsupra (SABA and ICS) |
| standard controllers | Reduce / prevent chronic inflammation: ICS Dilate airways: LABA Prevent release of mediators: LTRA |
| ICS is the | controller, first line of defense |
| biologic controllers | Reduce effects IgE / eosinophils Anti-IL-5 / Anti IgE |
| SABA used for | quick relief by opening airways |
| use of an inhaler | same as in COPD MDI and DPI |
| when teaching a pt how to use an inhaler, what should you do | ask pt to demonstrate technique |
| meds can also be administered when pt is | having an attack |
| albuterol causes | increase in anxiety and HR so be aware of this in a cardiac pt |
| how to use a nebulizer | put med in cup, attach mouthpiece or mask to the cup, attach the cup to compressor tubing, place mouthpiece in your mouth or place face mask over your nose and mouth then breath through your mouth until all med is gone |
| health promotion: pt should | Understand disease: “Do you have asthma all the time?” Monitor symptom severity (triggers): Symptom diary, Peak flow monitor Have an action plan: Adjust meds with change in symptoms |
| health promotion: pt should | Identify and avoid/manage triggers Be taught correct inhaler technique NOT use LABA alone – can take a combo drug with an ICS |
| why cant LABA be used alone | Black box warning!! May mask airway inflammation Greater risk of severe exacerbations without ICS |
| what is status asthmaticus | severe, life threatening bronchospasm |
| status asthmaticus | Can develop slowly or gradually Inadequate treatment Non adherence Severe asthma |
| asthma exacerbation | silent chest phenomenon |
| if pt doesn't respond to meds, then | Carefully monitor patient: Wheezing should decrease Peak flow should increase Able to talk in full sentences |
| caution for pt with asthma!! | No longer hear wheezing BUT is confused, tired, can’t speak full sentences = SILENT CHEST!!!! |
| what is the same with asthma and COPD | tests to monitor (PFTs) inhaler technique |
| what is different with asthma and COPD | Age at onset (COPD doesn't occur in young kids) Causative factors Medications (sequence / drugs) Patient response **no reversal for COPD but asthma can be treated and go back to normal |
| sleep related breathing disorders | continuum snoring / upper airway narrows / airway closes obstructive sleep apnea (OSA) |
| normal breathing | airway is open, air flows freely to lungs |
| obstructive sleep apnea (OSA) | airway collapses, blocked air flow to lungs |
| risk factors: gender | men, women (post menopausal) |
| risk factors: fat distribution | tongue, airway - so more likely in big guys with big necks/obesity |
| risk factors: anatomy | small upper airway |
| how to diagnose its OSA: pt history | Loud snoring Partner reports apnea Excessive daytime sleepiness Memory, learning, mood problems Impotence |
| how to confirm its OSA | Polysomnography (PSG) Sleep Study |
| AHI <5 | normal |
| AHI 5-15 | mild SOA |
| AHI 15-30 | moderate SOA |
| AHI >30 | severe SOA |
| home sleep test | similar data for majority, may require lab testing |
| how to manage symptoms of OSA | lifestyle changes and positive airway pressure |
| lifestyle changes | weight loss, avoid alcohol at night |
| positive airway pressure (PAP) | Pressure prevents airway closure Set to vary (or not) inspiration/expiration – Continuous (CPAP) – Varied pressure (BiPAP) Automatically varies – Auto Titrating (APAP) |
| CPAP | continuous |
| BiPAP | different on expiratory and inspiratory |
| APAP | depends on needs, auto titrated |
| pneumatic air splinting | therapy = gold standard |
| pneumatic air splinting must be | used daily |
| pneumatic air splinting | devices are portable, quiet, comfortable very effective in decreasing symptoms adherence is poor |
| is pneumatic air splinting successful? | Studies indicate: 10-15% abandon 1st weeks 20-40% adherent long term |
| CMS (medicare) requirement for payments of pneumatic air splinting | 4 hrs 70% nights Use 21 out of 30 days Electronic monitoring |
| mandibular (jaw) advancement works by | Pulls lower jaw forward Repositions tongue Opens airway |
| does mandibular (jaw) advancement work | AHI mild to moderate = Yes AHI severe = Limited |
| hypoglossal nerve stimulation: in sleep | muscles pharynx relax, airway obstructs |
| tongue position major factor | base tongue falls to back airway |
| Hypoglossal Nerve Stimulation Technique | Impulse generator Sensor intercostal muscle Electrode stimulates hypoglossal nerve Moves tongue forward to open airway |
| Hypoglossal Nerve Stimulator | senses pressure and will stimulate the hypoglossal cranial nerve |
Created by:
leh195